Provider Demographics
NPI:1114078862
Name:CASEY, MARK WORTHINGTON (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WORTHINGTON
Last Name:CASEY
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9805 TANDEM CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1553
Mailing Address - Country:US
Mailing Address - Phone:919-844-2969
Mailing Address - Fax:919-676-2588
Practice Address - Street 1:1985 UMSTEAD DR
Practice Address - Street 2:2501 MAIL SERVICE CENTER
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-2501
Practice Address - Country:US
Practice Address - Phone:919-855-4280
Practice Address - Fax:919-715-2738
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79131223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health